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Bursitis
Q: I was recently diagnosed with bursitis and have been in pain for over a month. For treatment, I have taken NSAIDs, rested, iced, and had one cortisone shot. However, I still have pain climbing the stairs in my house and bending my knees. How long does it take for bursitis to go away?
Answered by David Golden M.D.
A: : The bursa is a fluid-filled sac that allows practically frictionless gliding of ligaments and tendons. When they become inflamed, the term applied is bursitis. Bursitis can take a long time to heal. The knee has more than one bursa, and one or all of them can become inflamed. You have appropriately treated the inflammation with medication and modified activity, and even had an injection. The lidocaine in the injection provides temporary but instant relief and the steroid deposition is thought to provide long term anti-inflammatory relief. Avoiding inciting activity and allowing the bursitis to resolve is the mainstay of treatment. Wearing kneepads may also be beneficial if the padding protects the affected area. Some doctors will inject more than once if the injections are spread out more than a month or two apart. Allowing sufficient time is key. Rarely is surgery indicated to remove a bursa. Occasionally, the bursa can become infected, which may precipitate the need for surgery.
 
Q: I am a mason and spend a lot of time on my knees. In the past two weeks, my left knee has been bothering me; it is sore, tender and swollen. What is it and what should I do?
Answered by David Golden M.D.
A: It is difficult to answer your question. Where is the pain? What brought it on? Is there redness associated with it? Where is it tender to touch? Have you had this problem before? These are some of the questions that may aid in finding a diagnosis. If there is swelling in the joint, there is likely an abnormality with something in the joint rather than the surrounding tissues. Prior to seeing your doctor you should, rest, apply ice, and modify your activity level (avoid bearing weight and kneeling). Anti-inflammatory medications such as ibuprofen may help alleviate the pain. With your work, perhaps kneepads may be beneficial. Be sure to see your doctor to help determine the cause of your knee pain.
 
Q: After experiencing pain and swelling in my knee for the past two weeks, my doctor diagnosed me as having bursitis. He recommended resting, icing and taking NSAIDs, how come he didn’t drain the fluid from my knee?
Answered by David Golden M.D.
A: There are risks and benefits to everything doctors do. Bursitis is most often a self-limiting disease, which means that it will likely improve with time, no matter what is done to treat it. When an orthopedist aspirates the bursa (withdraws fluid) with a needle, there is a small but definite risk of introducing infection into the bursa. Additionally, bursitis has a tendency to recur, even despite aspiration. There is also a small risk of causing a draining hole through the skin because of the needle tract. For that reason, aspiration is not commonly done for bursitis. When it is, the risks need to be understood and outweighed by the benefits, which include decreased pain and swelling.
 
Q: I have tried everything (including having my knee drained) to alleviate the pain that I experience from bursitis, but nothing works. As a last resort, I have heard that the bursa sac can be removed. Can you tell me more about this surgical procedure? Is it successful? Is there a risk in removing the bursa?
Answered by David Golden M.D.
A: After all options for non-operative treatment of chronic bursitis are tried, the last resort is resection, or removal, of the bursa. There is always risk involved with every surgical procedure. They include, but are not limited to: bleeding, infection, nerve injury, scarring, and, in the case of bursa resection, the risk of recurrence. Success is anticipated if the appropriate candidate is chosen for surgery. Be sure to ask the doctor all your questions so that you are satisfied with the reasons and the risks associated with surgery. It is not a very commonly performed operation because of the success rate of non-operative treatment.
 
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